Treatment and Outcomes of Acute Ischemic Stroke

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: closed (10 February 2022) | Viewed by 13378

Special Issue Editor

Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
Interests: machine learning; artificial intelligence; swallowing rehabilitation; stroke; outcome; neuroplasticity; gene polymorphism; aspiration pneumonia

Special Issue Information

Dear Colleagues,

Stroke is one of the leading causes of human disability, and despite the advances in reperfusion technologies, there is an increased number of stroke patients who survive with impaired functional outcomes. Development of treatment strategies that promote recovery to minimize poststroke disabilities is needed. Moreover, the introduction of algorithms that can help in the early identification of those who may be at increased risk of poor outcomes is also necessary.

For this Special Issue titled “Treatment and Outcomes of Acute Ischemic Stroke”, we would like to invite authors across various clinical specialties to submit their original papers or review articles on specific and novel approaches in ischemic stroke.

This issue will focus on the advances and innovations in restorative therapies that enhance the patient’s poststroke outcome, highlighting novel systems or devices and outcomes of clinical management protocols.

Articles on innovative interventions using brain stimulation, neurostimulation or new pharmacological therapies, or physical activities that promote recovery and neuroplasticity would be welcome for submission.

This issue will also be open to articles focusing on neuroimaging, neurophysiological methods (e.g., EEG and related techniques), or studies on predictive algorithms that can forecast poststroke outcomes using sophisticated machine learning techniques.

Prof. Dr. Sun Im
Guest Editor

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Keywords

  • Machine Learning
  • Stroke
  • Neuroplasticity
  • Brain stimulation
  • Neuroimaging
  • Telerehabilitation
  • Prognostication
  • Algorithms
  • Clinical protocol
  • Neurorehabilitation

Published Papers (6 papers)

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Research

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15 pages, 1198 KiB  
Article
High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study
by Ying-Chu Chen, Tai-Li Chen, Chia-Chun Cheng, Yu-Cih Yang, Jen-Hung Wang, Hei-Tung Yip, Chung-Yi Hsu and Hung-Yu Cheng
Medicina 2022, 58(3), 402; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58030402 - 08 Mar 2022
Cited by 2 | Viewed by 2561
Abstract
Background and Objectives: Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. Materials and Methods: Data of patients diagnosed [...] Read more.
Background and Objectives: Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. Materials and Methods: Data of patients diagnosed with stroke between 2000 and 2012 were collected from the 2000 Longitudinal Health Insurance Database (Taiwan). Based on the number of rehabilitation sessions attended within 90 days of discharge, the rehabilitation intensity was classified as low, medium, or high. After adjusting for sociodemographic factors and comorbidities, the Cox proportional hazards model evaluated the risk of PU development during the 12-year follow-up period. Kaplan–Meier curves were used to estimate the cumulative incidence of PUs. Results: Our study included 18,971 patients who had their first episode of stroke. Of these, 9829 (51.8%) underwent rehabilitation therapy after discharge. Female patients and patients with a National Institutes of Health Stroke Scale (NIHSS) score >13 points, who commenced high-intensity post-stroke rehabilitation after discharge had a significantly lower risk of PU development than those who underwent low-intensity post-stroke rehabilitation after discharge. Cumulative survival analysis showed a significantly lower cumulative incidence of PU during the 12-year follow-up period in the high-intensity rehabilitation group. Conclusion: Compared with low-intensity post-stroke rehabilitation, high-intensity post-stroke rehabilitation after discharge from hospital is associated with a lower risk of post-stroke PU development, especially in female stroke patients and patients with a NIHSS score >13 points. High-intensity rehabilitation is also associated with a significantly lower cumulative incidence of PU events during the 12-year follow-up period. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)
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10 pages, 753 KiB  
Article
Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study
by Nicola Lamberti, Fabio Manfredini, Luc Oscar Lissom, Susanna Lavezzi, Nino Basaglia and Sofia Straudi
Medicina 2021, 57(11), 1200; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111200 - 03 Nov 2021
Cited by 5 | Viewed by 1757
Abstract
Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials [...] Read more.
Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials and Methods: In this study, 236 participants (145 males, 91 females) were admitted to a rehabilitation facility after experiencing a stroke and performed RAGT within a multidisciplinary rehabilitation program. Functional Independence Measure (FIM) and Functional Ambulatory Category (FAC) were assessed at admission and discharge to determine sex-related outcomes. Results: At the baseline, no significant difference among sexes was observed. At the end of rehabilitation, both males and females exhibited significant improvements in FIM (71% of males and 80% of females reaching the MCID cut-off value) and FAC (∆score: men 1.9 ± 1.0; women 2.1 ± 1.1). A more remarkable improvement was observed in women of the whole population during the study, but statistical significance was not reached. When analysing the FAC variations with respect to the total number of RAGT sessions, a more significant improvement was observed in women than men (p = 0.025). Conclusion: In conclusion, among subacute stroke patients, benefits were observed following RAGT during a multidisciplinary rehabilitation program in both sexes. A greater significant recovery for women with an ischemic stroke or concerning the number of sessions attended was also highlighted. The use of gait robotics for female patients may favour a selective functional recovery after stroke. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)
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17 pages, 1785 KiB  
Article
Could Self-Control and Emotion Influence Physical Ability and Functional Recovery after Stroke?
by Yu-Won Choe and Myoung-Kwon Kim
Medicina 2021, 57(10), 1042; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101042 - 30 Sep 2021
Cited by 6 | Viewed by 1651
Abstract
Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients’ physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 [...] Read more.
Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients’ physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 ± 10.31; days after stroke: 42.66 ± 8.84). The subjects participated in tests at the baseline, four weeks later, and eight weeks later. Subjects were asked to complete the following: (1) self-control level test, (2) positive and negative emotion test, (3) knee muscle strength testing, (4) static balance test, (5) gait measurement, and (6) activities of daily living evaluation. Results: The muscle strength of the knee, static balance, gait ability, and the Functional Independence Measure score increased significantly in the stroke patients over time. A significant correlation was noted between the emotion and physical variables in stroke patients. The self-control level was significantly associated with the change in the physical variables in stroke patients over time. Conclusions: The self-control level was positively related to the increases in functional recovery of stroke patients with time, while the emotions were related more to the physical abilities. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)
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7 pages, 512 KiB  
Article
The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability
by Ho-Jun Yi, Dong-Hoon Lee, Bo-Young Hong, Seung-Yoon Song, Yeun-Jie Yoo, Mi-Jeong Yoon, Jae-Hoon Sung and Seong-Hoon Lim
Medicina 2021, 57(5), 509; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050509 - 19 May 2021
Cited by 1 | Viewed by 1789
Abstract
Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We [...] Read more.
Background and Objectives: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3–5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. Materials and Methods: This retrospective longitudinal case–control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12–16 days), four weeks (26–30 days), and six months (180–210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. Results: The MBI, mRS, FAC, and DOSS scores all improved significantly (all p < 0.05) in the EVT group, compared to the controls. Conclusions: EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)
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11 pages, 563 KiB  
Article
The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage
by Mateusz Lucki, Ewa Chlebuś, Agnieszka Wareńczak and Przemysław Lisiński
Medicina 2021, 57(3), 190; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030190 - 24 Feb 2021
Cited by 4 | Viewed by 1744
Abstract
Background and objectives: Patients with a history of prior stroke have a high risk for subsequent cardiovascular events (CVD). Therefore, the implementation of an effective strategy to reduce risk factors and thereby improve secondary prevention outcomes is crucial in this patient population. [...] Read more.
Background and objectives: Patients with a history of prior stroke have a high risk for subsequent cardiovascular events (CVD). Therefore, the implementation of an effective strategy to reduce risk factors and thereby improve secondary prevention outcomes is crucial in this patient population. The aim of this study was to determine differences in the incidence of risk factors for recurrent CVD events based on clinical type of prior stroke and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 109 patients with a history of ischemic stroke (IS) and 80 patients with a history of intracerebral hemorrhage (ICH) within 14 days poststroke. Results: Atrial fibrillation/flutter (p = 0.031), >70% carotid artery stenosis (p = 0.004), blood pressure >140/90 mmHg (p = 0.025), blood HbA1c levels >7% (p = 0.002), smoking (p = 0.026) and NSAID (nonsteroidal anti-inflammatory drug) use (p < 0.001) were significantly more common in patients with a history of ischemic stroke. However, liver function test abnormalities were observed more commonly in patients with a history of hemorrhagic stroke (p = 0.025). Conclusions: The incidence and type of risk factors for recurrent CVD events vary according to the clinical type of prior stroke. The ICF classification system is a useful tool for evaluating these risk factors. This may help reduce the risk of subsequent CVD events. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)

Review

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16 pages, 349 KiB  
Review
MiRNA: Involvement of the MAPK Pathway in Ischemic Stroke. A Promising Therapeutic Target
by Agnese Gugliandolo, Serena Silvestro, Cinzia Sindona, Placido Bramanti and Emanuela Mazzon
Medicina 2021, 57(10), 1053; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101053 - 01 Oct 2021
Cited by 16 | Viewed by 3011
Abstract
Ischemic stroke (IS) is a cerebrovascular disease with a high rate of disability and mortality. It is classified as the second leading cause of death that arises from the sudden occlusion of small vessels in the brain with consequent lack of oxygen and [...] Read more.
Ischemic stroke (IS) is a cerebrovascular disease with a high rate of disability and mortality. It is classified as the second leading cause of death that arises from the sudden occlusion of small vessels in the brain with consequent lack of oxygen and nutrients in the brain tissue. Following an acute ischemic event, the cascade of events promotes the activation of multiple signaling pathways responsible for irreversible neuronal damage. The mitogen-activated protein kinase (MAPK) signaling pathway transmits signals from the cell membrane to the nucleus in response to different stimuli, regulating proliferation, differentiation, inflammation, and apoptosis. Several lines of evidence showed that MAPK is an important regulator of ischemic and hemorrhagic cerebral vascular disease; indeed, it can impair blood–brain barrier (BBB) integrity and exacerbate neuroinflammation through the release of pro-inflammatory mediators implementing neurovascular damage after ischemic stroke. This review aims to illustrate the miRNAs involved in the regulation of MAPK in IS, in order to highlight possible targets for potential neuroprotective treatments. We also discuss some miRNAs (miR), including miR-145, miR-137, miR-493, and miR-126, that are important as they modulate processes such as apoptosis, neuroinflammation, neurogenesis, and angiogenesis through the regulation of the MAPK pathway in cerebral IS. To date, limited drug therapies are available for the treatment of IS; therefore, it is necessary to implement preclinical and clinical studies aimed at discovering novel therapeutic approaches to minimize post-stroke neurological damage. Full article
(This article belongs to the Special Issue Treatment and Outcomes of Acute Ischemic Stroke)
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